pelvic inflammatory disease (PID) - causes, symptoms and treatment

What is Pelvic Inflammatory Disease

A bacterial INFECTION involving the UTERUS, FALLOPIAN TUBES, CERVIX, and VAGINA. Untreated PID has the potential to become life threatening if it spreads to involve the peritoneal membrane (PERITONITIS), the tissue that encloses the abdominal cavity. Because PID can cause scarring within the fallopian tubes that occludes them (blocks the tubes’ openings), chronic or recurrent PID is a leading cause of INFERTILITY in women. PID is a significant health concern in the United States with doctors diagnosing more than one million women with it each year, about half of whom have permanently impaired FERTILITY as a consequence.

Causes of Pelvic Inflammatory Disease

The most common cause of PID is recurrent or untreated infection with SEXUALLY TRANSMITTED DISEASES (STDS) such as CHLAMYDIA and GONORRHEA. Other causes include infection that occurs as a postoperative complication after a surgical procedure such as DILATION AND CURETTAGE (D&C) or elective ABORTION. A less common cause of PID is infection resulting from an intrauterine device (IUD), a form of long-term birth control.

Symptoms of Pelvic Inflammatory Disease and Diagnostic Path

It is possible to have PID, especially chronic PID, with few or no symptoms. Many women who have PID typically appear quite ill, however, and may have FEVER and chills in addition to other symptoms. Such symptoms may include

  • yellowish or greenish malodorous (foulsmelling) vaginal discharge
  • lower abdominal tenderness, cramping, or PAIN
  • vaginal bleeding between menstrual periods
  • irregular or unusually heavy menstrual periods

The diagnostic path includes PELVIC EXAMINATION with vaginal discharge and tissue samples for laboratory analysis and BLOOD tests to evaluate the presence of infection or INFLAMMATION within the body (such as elevated sedimentation rate, white blood cell count, and C-REACTIVE PROTEIN). The cervix and uterus are generally very tender to palpation during the pelvic exam, which is a key diagnostic criterion.

Pelvic Inflammatory Disease Treatment Options and Outlook

Treatment is prompt administration of ANTIBIOTIC MEDICATIONS, by intravenous (IV) or intramuscular injection for severe symptoms and orally otherwise. Antibiotic therapy may include two or more antibiotic medications, depending on the identified BACTERIA present in the vaginal and cervical cultures. It is essential to take the full course of all antibiotics as prescribed to completely eradicate the infection, which cures the PID. ANALGESIC MEDICATIONS relieve pain and reduce fever to improve comfort. Possible complications of PID include infertility, increased risk for ECTOPIC PREGNANCY, and chronic pelvic pain. The likelihood of these complications increases with each episode of PID, though prompt diagnosis and treatment helps mitigate their risk.

ampicillin/sulbactam cefotetan
cefoxitin ceftriaxone
ciprofloxacin clindamycin
doxycycline gentamicin
metronidazole ofloxacin

Risk Factors and Preventive Measures

The primary risk factor for PID is untreated STD infection. Many people do not have symptoms of STDs yet are infected and pass the infections to their sex partners. Multiple sex partners and unprotected sex are high-risk behaviors for STDs and PID. Measures to prevent infection among sexually active adults include mutual monogamy and latex condom use with every sexual act.


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